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Diabetes Prevention — UKMLA MCQ

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ModerateDiabetes PreventionUKMLAMRCGP AKTPARAMRCEM SBAMRCP Part 1PSA

A 50-year-old man has a BMI of 41 kg/m² and obstructive sleep apnoea. He is asymptomatic, and his latest HbA1c is 45 mmol/mol (6.3%). He has not previously participated in an intensive lifestyle-change programme and is willing to do so. Which is the most appropriate intervention to reduce his risk of developing type 2 diabetes?

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Correct answer: D — Refer to a quality-assured intensive lifestyle-change programme

An HbA1c of 45 mmol/mol is within the non-diabetic hyperglycaemia range of 42–47 mmol/mol. NICE recommends referral to an evidence-based, quality-assured intensive lifestyle-change programme, addressing diet, weight reduction and physical activity. A realistic initial weight-loss target is 5–10% over 1 year, with activity progressing towards UK recommendations. Severe obesity increases his risk but does not, by itself, make immediate metformin the preferred first intervention. Metformin may be considered if glycaemia deteriorates despite participation in intensive lifestyle change or if he cannot participate, particularly when BMI is above 35 kg/m². An HbA1c below 48 mmol/mol does not diagnose diabetes, so option B is incorrect. Options A and E inappropriately defer effective preventive intervention.

Reference: NICE. Type 2 diabetes: prevention in people at high risk (PH38), recommendations 1.5.4, 1.9.1, 1.13.1 and 1.19.1. Published 2012; updated 2017. https://www.nice.org.uk/guidance/ph38/chapter/recommendations